Abstract
AIM: To compare the short-term effect of carvedilol and propranolol in the reduction of hepatic venous pressure gradient (HVPG) in patients with cirrhotic portal hypertension.
METHODS: Ninety-six patients with cirrhotic portal hypertension were randomly divided into either an experiment group or a control group. The experiment group was treated with carvedilol, and the control group was treated with propranolol. The levels of wedged hepatic venous pressure (WHVP), free hepatic venous pressure (FHVP), HVPG, mean arterial pressure (MAP), heart rate (HR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), serum creatinine (SCr), blood urea nitrogen (BUN) and adverse drug reactions were compared between the two groups.
RESULTS: The levels of WHVP, HVPG, MAP and HR in the experiment group were significantly lower after treatment than prior treatment (16.26 mmHg ± 5.28 mmHg vs 18.42 mmHg ± 6.83 mmHg, 10.01 mmHg ± 3.77 mmHg vs 13.42 mmHg ± 5.68 mmHg, 85.58 mmHg ± 10.42 mmHg vs 95.16 mmHg ± 12.03 mmHg, 62.99/min ± 5.24/min vs 75.39/min ± 7.78/min, P < 0.05). The levels of HVPG, MAP and HR in the control group were significantly lower after treatment than prior treatment (12.03 mmHg ± 4.63 mmHg vs 13.54 mmHg ± 5.78 mmHg, 89.52 mmHg ± 12.55 mmHg vs 95.29 mmHg ± 13.25 mmHg, 61.08/min ± 7.66/min vs 73.98/min ± 6.46/min, P < 0.05). There was no significant difference in the percentage of HVPG responders between the two groups (56.25% vs 41.67%, P > 0.05). The decreases in HVPG and MAP in the experiment group were more significant than those in the control group (28.30% ± 22.19% vs 12.38% ± 24.09%, 10.67% ± 6.77% vs 6.06% ± 5.79%, P < 0.05). The levels of SCr in the control group were significantly lower post treatment than prior treatment (70.82 mg/d ± 11.60 mg/d vs 76.57 mg/d ± 15.22 mg/d, P < 0.05). There were no significant differences for the experiment group in the levels of liver and kidney function indicators (36.79 IU/L ± 19.62 IU/L vs 48.84 IU/L ± 31.66 IU/L, 44.55 IU/L ± 21.41 IU/L vs 46.42 IU/L ± 24.81 IU/L, 26.56 μmol/L ± 16.43 μmol/L vs 25.94 μmol/L ± 18.30 μmol/L, 74.97 mg/d ± 15.33 mg/d vs 75.71 mg/d ± 12.33 mg/d, 5.02 mg/d ± 2.47 mg/d vs 5.26 mg/d ± 1.69 mg/d, P > 0.05). No obvious adverse reactions or exacerbation occurred.
CONCLUSION: Both carvedilol and propranolol have good clinical effects in patients with cirrhotic portal hypertension in terms of reduction of HVPG, reducing the risk of esophagogastric varices bleeding, no obvious effects on liver and kidney function, and no adverse reactions, and carvedilol has better clinical effects.
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